Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China.
Department of Neonatology, Ministry of Education Key Laboratory of Child Development and Disorders China International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, 400014, Chongqing, People's Republic of China.
Eur J Pediatr. 2022 Jan;181(1):215-223. doi: 10.1007/s00431-021-04190-0. Epub 2021 Jul 12.
Nasal high-frequency oscillatory ventilation (NHFOV) is a new respiratory support strategy despite lacking of enough evidence in preterm infants with respiratory distress syndrome (RDS). The aim of the present systematic review was to explore whether NHFOV reduced the intubation rate as compared with nasal continuous positive airway pressure (NCPAP) as the primary respiratory support strategies in preterm infants with RDS. Medline, the Cochrane library, the Cochrane Controlled Trials Register, EMBASE, Chinese National Knowledge Infrastructure (CNKI), and Wanfang data Information Site were searched from inception to Jan 1, 2021(Prospero2019 CRD42019129316, date and name of registration: Apr 23,2019, The clinical effectiveness of NHFOV vs NCPAP for preterm babies with respiratory distress syndrome). Pooled data from clinically randomized controlled trials (RCTs) comparing NHFOV with NCPAP as the primary respiratory supporting strategies in preterm infants with RDS were performed using the fixed-effects models whenever no heterogeneity was shown. The primary outcome was intubation rate. Four randomized controlled trials involving 570 participants were included. Comparing with NCPAP, NHFOV resulted in less intubation (relative risk (RR) 0.44; 95% confidence interval (CI) 0.29-0.67, P = 0.0002), and heterogeneity was not found among the trials in the fixed-effects model (P = 0.78, I = 0%). Similar result also appeared in sensitivity analysis after excluding one study with significant difference (RR 0.44; 95% CI 0.25-0.78, P = 0.005) (P = 0.58, I = 0%).Conclusion: NHFOV decreased the intubation rate as compared with NCPAP as primary respiratory supporting strategies in preterm infants suffering from RDS. Future research should assess whether NHFOV can reduce the incidence of bronchopulmonary dysplasia (BPD) and intubation rate in preterm infants with BPD. Fund by Natural Science Foundation of Chongqing (cstc2020jcyj-msxmX0197), and "guan'ai" preterm Study Program of Renze Foundation of Beijing(K022). What is Known: • Nasal high-frequency oscillatory ventilation (NHFOV) has been described to be another advanced version of nasal continuous positive airway pressure (NCPAP). However, its beneficial effects among different studies as the primary modes in the early life of preterm infants with respiratory distress syndrome (RDS) were inconsistent. What is New: • Comparing with NCPAP, NHFOV decreases the risk of intubation as a primary respiratory supporting strategy in early life for preterm infants suffering from RDS.
经鼻高频振荡通气（NHFOV）是一种新的呼吸支持策略，尽管在患有呼吸窘迫综合征（RDS）的早产儿中缺乏足够的证据。本系统评价的目的是探讨与鼻持续气道正压通气（NCPAP）作为 RDS 早产儿的主要呼吸支持策略相比，NHFOV 是否降低了插管率。从建库到 2021 年 1 月 1 日，检索了 Medline、Cochrane 图书馆、Cochrane 对照试验注册中心、EMBASE、中国知网（CNKI）和万方数据知识服务平台，检索词为“鼻高频振荡通气”和“呼吸窘迫综合征”。对比较 NHFOV 与 NCPAP 作为 RDS 早产儿主要呼吸支持策略的临床随机对照试验（RCTs）进行了合并数据分析，当没有异质性时采用固定效应模型。主要结局为插管率。纳入了 4 项随机对照试验，共 570 名参与者。与 NCPAP 相比，NHFOV 降低了插管率（相对风险（RR）0.44；95%置信区间（CI）0.29-0.67，P=0.0002），且固定效应模型中试验间无异质性（P=0.78，I=0%）。在排除一项差异显著的研究后（RR 0.44；95% CI 0.25-0.78，P=0.005）（P=0.58，I=0%），敏感性分析也得出了类似的结果。结论：与 NCPAP 作为主要呼吸支持策略相比，NHFOV 降低了 RDS 早产儿的插管率。未来的研究应评估 NHFOV 是否可以降低患有 BPD 的早产儿的 BPD 发生率和插管率。本研究由重庆市自然科学基金（cstc2020jcyj-msxmX0197）和北京恩泽慈善基金会“关爱”早产儿研究项目资助。已知：•经鼻高频振荡通气（NHFOV）是经鼻持续气道正压通气（NCPAP）的另一种改良版本。然而，其在不同研究中作为 RDS 早产儿早期生命的主要模式的有益效果不一致。新发现：•与 NCPAP 相比，NHFOV 降低了作为 RDS 早产儿早期生命主要呼吸支持策略的插管风险。
